也。病呕而吐，食久反出，是无火也。暴速注下，食不及化，是有火也。溏泄而久，止发无恒，是无火也。故
心盛则生热，肾盛则生寒，肾虚则寒动于中，心虚则热收于内。又热不得寒，是无火也；寒不得热，是无水也。
夫寒之不寒，责其无水；热之不热，责其无火。热之不久，责心之虚；寒之不久，责肾之少。有者泻之，无者补
之，虚者补之，盛者泻之，居其中间，疏其壅塞，令上下无碍，血气通调，则寒热自和，阴阳调达矣。是以方
有治热以寒，寒之而水食不入，攻寒以热，热之而昏躁以生，是则气不疏通，壅而为是也。纪于水火，余气可知。
故曰有者求之，无者求之，盛者责之，虚者责之，令气条达，道之妙也。五胜谓五行更胜也，先以五行寒暑温
凉湿，酸咸甘辛苦，相胜为法也。按∶张景岳曰∶“有者言其实，无者言其虚，求之者求有无之本也，譬犹寻物
一般，必得其所，取之则易。如太阴雨化，施于太阳；太阳寒化，施于少阴∶少阴火化，施于阳明；阳明燥化，
施于厥阴；厥阴风化，施于太阴。凡淫胜在我者，我之实也，实者真邪也；反胜在彼者，我之虚也，虚者假邪也。
此六气之虚实，即所谓有无也。然天地运气虽分五六，而阴阳之用水火而已，故阳胜则阴病，阴胜则阳病，泻其
盛气，责其实也，培其衰气，责其无也。设不明逆顺虚实之道，未免实实虚虚，遗人害矣。”）
帝曰∶善！五味阴阳之用何如？岐伯曰∶辛甘发散为阳，酸苦涌泄为阴，咸味涌泄为阴，淡味渗泄为阳，
六者或收或散，或缓或急，或燥或润，或 或坚，以所利而行之，调其气，使其平也。（涌，吐也。泄，利也。
渗泄，小便也。言水液自回肠，泌别汁，渗入膀胱之中，自胞气化之而为溺以泄出也。按∶辛甘酸苦咸，五味也。
五味之外又有淡，淡居五味之先，其气轻清，故主渗泄，所以泄五味之滞者也。合而言之有六者，分而言之则各
有所利，随其所利而行之，病气可调也。然辛甘主发散，淡味主渗泄，均属之阳，易明也。其酸苦咸味之均属阴，
亦易明也。而并主涌泄者何故？夫涌者吐也，泄者利也，病之欲吐欲利者，多是有物郁积于中。酸性收敛而属木，
故能敛所积之物而上涌；苦性属寒而逐火，故
能驱所积之物而下泄；若夫咸则又能 坚而润燥，故上以涌痰积于胸喉，下以泄垢移于肠胃，各有所利，在乎
行之者耳。）帝曰∶非调气而得者，治之奈何？有毒无毒，何先何后，愿闻其道。（夫病生之类有四焉∶一者
始因气动而内有所成，二者不因气动而外有所成，三者始因气动而病生于内，四者不因气动而病生于外。夫因气
动而内成者，谓积聚 瘕，瘤气瘿气，结核癫痫之类也。外成者，谓痈肿疮疡，痂疥疽痔，掉螈浮肿，目赤瘭疹，
肿痛痒之类也。不因气动而病生于内者，谓留饮 食，饥饱劳损，宿食霍乱，悲恐喜怒，想慕忧结之类也。生
于外者，谓瘴气贼魅，虫蛇蛊毒，蜚尸鬼击，冲薄坠堕，风寒暑湿，砍射刺割捶扑之类也。如是四类，有独治内
而愈者，有兼治内而愈者，有独治外而愈者，有兼治外而愈者，有先治内后治外而愈者，有先治外后治内而愈者，
有须齐毒而攻击者，有须无毒而调引者。凡此之类，方法所施，或重或轻，或缓或急，或收或散，或润或燥，
或或坚，方士之用，见解不同，各擅己心，好丹非素，故复问之也。按∶病生之类，王注言之详矣，然是泛论
治因之法，非解经也。夫所谓非调气而得者，谓上文收散缓急八者乃调气之法，言此外更有治法否。）岐伯曰∶
有毒无毒，所治为主，适大小为制也。（言但能破积愈疾，解急脱死，则为良方，非必要言以先毒为是，后毒为非，
无毒为非，有毒为是，必量病轻重大小制之者也。）帝曰∶请言其制。岐伯曰∶君一臣二，制之小也。君一臣三
佐五，制之中也。君一臣三佐九，制之大也。寒者热之，热者寒之，微者逆之，甚者从之，（夫病之微小者，犹
人火也，遇草而 ，得木而燔，可以湿伏，可以水灭，故逆其性气以折之攻之。病之大甚者，犹龙火也，得湿而焰，
遇水而燔，不知其性，以水湿折之，适足以光焰诣天，物穷方止矣。识其性者，反常之理，以火逐之，则燔灼自
消，焰光扑灭。然逆之谓以寒攻热，以热攻寒，从之谓攻以寒热，虽从其性用，不必皆同，是以下文曰逆者正治，
从者反治，从少从多，观其事也。此之谓乎。按∶
张景岳曰∶“病之微者，如阳病则热，阴病则寒，真形易见，其病则微，故可逆之，逆即上文之正治也。病之
甚者，如热极反寒，寒极反热，假证难辨，其病则甚，故当从之，从即下文之反治也。”）坚者削之，客者除
之，劳者温之，结者散之，留者攻之，燥者濡之，急者缓之，散者收之，损者益之，逸者行之，惊者平之，上
之下之，摩之浴之，薄之劫之，开之发之，适事为故。（按∶坚者，积块也。客者，外邪也，除之谓表而驱之也。
温之谓温养之也，举痛论言，劳则气耗，气既耗矣，若更用寒凉，则凝滞而害益甚，故必温养为宜也。逸，奔
逸也，内乱欲出，导之使行也。平有二义∶一谓抑其有余，一谓安其溃乱也。上下，吐利也。摩，按摩，所以
运其涩滞也。浴，澡浴，所以洗濯垢秽也。薄者，搜蕴蓄之邪；劫者，夺强盛之势也。适事为故，谓病必有故，
有故则有事，适其当行之事而知其故矣。）帝曰∶何谓逆从？岐伯曰∶逆者正治，从者反治，从少从多，观其
事也。（按，张景岳曰∶“以寒治热，以热治寒，逆其病者，谓之正治；以寒治寒，以热治热，从其病者，谓
之反治。从少谓一同而二异，从多谓二同而一异，必观其事之轻重而为之增损，然则宜于全反者，自当尽同无
疑矣。又治有逆从者，以病有微甚，病有微甚者，以证有真假也。寒热有真假，虚实亦有真假，真者正治，治
之无难，假者反治，乃为难耳。如寒热之真假者，真寒则脉沉而细，或弱而迟，为厥逆，为呕吐，为腹痛，为
飧泄下利，为小便清频，即有发热，必欲得衣，此浮热在外，而沉寒在内也。真热则脉数有力，滑大而实，为
烦躁喘满，为音声壮厉，或大便秘结，或小水赤涩，或发热掀衣，或胀痛热渴，此皆真病，真寒者宜温其寒，
真热者宜解其热，是当正治者也。至若假寒者，阳证似阴，火极似水也，外虽寒而内则热，脉数而有力，或沉
而鼓击，或身寒恶衣，或便热结秘，或烦渴引饮，或肠垢臭秽，此则恶寒非寒，明是热证，所谓热极反兼寒化，
亦曰阳盛隔阴也。假热者，阴证似阳，水极似火也，外虽热而内则寒，脉微而弱，或数而虚，或浮大而无根，
或弦芤而断续，身虽炽热而神则静，语虽谵妄而声则微，或虚狂起倒而禁之
即止，或蚊迹假斑而浅红细碎，或喜冷水而实饮不多，或舌苔面赤而衣被不撤，或小水多利，或大便溏滑，此则
恶热非热，明是寒证，所谓寒极反兼热化，亦曰阴盛隔阳也。此皆假病，假寒者清其内热，内清则浮阴退舍矣，
假热者温其真阳，中温则虚火归原矣，是当从治者也。又如虚实之治，实则泻之，虚则补之，此不易之法也。
然至虚有盛候，则有假实矣；大实有羸状，则有假虚矣。总之虚者正气虚也，为色惨形疲，为神衰气怯，或自
汗不收，或二便失禁，或梦遗精滑，或呕吐隔塞，或病久攻多，或气短似喘，或劳伤过度，或暴困失志，虽外证
似实而脉弱无神者，皆虚证之当补也。实者邪气实也，或外闭于经络，或内结于脏腑，或气壅而不行，或血留
而滞凝，必脉证俱盛者，乃实证之当攻也。是虚实之间，最多疑似，有不可不辨其真耳。如通评虚实论曰∶‘邪
气盛则实，精气夺则虚。’此虚实之大法也。设有人焉，正已夺而邪方盛者，将顾其正而补之乎？抑先其邪而
攻之乎？见有不的，则生死系之，此其所以宜慎也。夫正者本也，邪者标也，若正气既虚，邪气虽盛，亦不可
攻，盖恐邪未去而正先脱，呼吸变生，则措手无及，故治虚邪者当先顾正气，正气存则不致于害。且补中自有
攻意，盖补阴即所以攻热，补阳即所以攻寒，世未有正气复而邪不退者，亦未有正气竭而命不倾者。如必不得已，
亦当酌量缓急，暂从权宜，从少从多，寓战于守，斯可矣，此治虚之道也。若正气无损者，邪气虽微，自不宜
补，盖补之则正无与而邪反盛，适足以借寇兵而资盗粮，故治实证者当直去其邪，邪去则身安，此治实之道也。
要之能胜攻者方是实证，实者可攻，何虑之有，不能胜攻者便是虚证，气去不返，可不寒心，此邪正之辨，不
可不知也。惟是假虚之证不多见，而假实之证最多也。假寒之证不难治，而假热之证易误也。然实者多热，虚者
多寒。如丹溪曰，气有余，便是火，故实能受寒；而余续之曰，气不足，便是寒，故虚能受热。世有不明真假
本末，而曰知医者，余则未敢许也。”景岳先生此论，明白畅快，正治从治之法无遗议矣，真是羽翼圣经，
而补启玄之所未及，其功伟哉！）帝曰∶反治何谓？岐伯曰∶热因寒用，寒因热用，塞因塞用，通因通用，
必伏其所主而先其所因，其始则同，其终则
异，可使破积，可使溃坚，可使气和，可使必已。（按∶张景岳曰∶“热因寒用者，如大寒内结，当治以热，
然寒甚格热，热不得前，则以热药冷服，下咽之后，冷体既消，热性便发，情且不违而致大益，此热因寒用之
法也。寒因热用者，如大热在中，以寒攻治则不入，以热攻治则病增，乃以寒药热服，入腹之后，热气既消，
寒性遂行，情且协和而病以减，此寒因热用之法也。如五常政大论云∶‘治热以寒，温而行之；治寒以热，凉
而行之。’亦寒因热用，热因寒用之义。塞因塞用者，如下气虚乏，中焦气壅，欲散满则更虚于下，欲补下则
满甚于中，治不知本而先攻其满，药入或减，药过依然，气必更虚，病必渐甚，乃不知少服则资壅，多服则宣
通，峻补其下以疏启其中，则下虚自实，中满自除，此塞因塞用之法也。通因通用者，如大热内蓄，或大寒
内凝，积聚留滞，泻利不止，寒滞者以热下之，热滞者以寒下之，此通因通用之法也。以上四治，必伏其所主
者，制病之本也。先其所因者，求病之由也。既得其本，而以真治真，以假治假，其始也类治似同，其终也病
变则异矣，是为反治之法，故可使破积溃坚，气和而病必已也。”谨按此景岳合王注及新校正等注润饰而成者，
更为清顺，故录之。塞，入声。）帝曰∶善！调气而得者何如？岐伯曰∶逆之从之，逆而从之，从而逆之，疏
气令调，则其道也。（按∶景岳曰∶“气调而得者，言气本调和而偶感于病，则或因天时，或因意料之外者也。
若其治法亦无过逆从而已，或可逆者，或可从者，或先逆而后从者，或先从而后逆者，但疏其邪气而使之调和，
则治道尽矣。”）
帝曰∶善！病之中外何如？岐伯曰∶从内之外者调其内，从外之内者治其外。（各绝其源。）从内之外而
盛于外者，先调其内而后治其外；从外之内而盛于内者，先治其外而后调其内。（皆谓先除其根属，后削其枝条也。）
中外不相及，则治主病。（……中外不相及，自各一病也。按∶阴阳应象大论曰∶“治病必求于本。”本者，
病之所起者是也。先本
后末，治病之次序，不可不知也。）
帝曰∶论言治寒以热，治热以寒，而方士不能废绳墨而更其道也。有病热者寒之而热，有病寒者热之而寒，
二者皆在，新病复起，奈何治？（按∶此问治之误者，盖但知正治而不知从治者也。嗟乎！彼所谓拘绳守墨者，
乃其废绳彻墨者也。）岐伯曰∶诸寒之而热者取之阴，热之而寒者取之阳，所谓求其属也。（言益火之原以消阴
翳，壮水之主以制阳光，故曰求其属也。夫粗工褊浅，学未精深，以热攻寒，以寒疗热，治热未已而冷疾已生，
攻寒日深而热病更起，热起而中寒尚在，寒生而外热不除，欲攻寒则惧热不前，欲疗热则思寒又止，进退交战，
危亟已臻，岂知脏腑之源，有寒热温凉之主哉。取心者不必齐以热，取肾者不必齐以寒，但益心之阳，寒亦通
行，强肾之阴，热之犹可。观斯之故，或治热以热，治寒以寒，万举万全。呜呼！人之死者，岂非方士愚昧杀之
耶。按∶益火之原以消阴翳二语，治法之精义也，发前人所未发，为后学之津梁，伟哉启玄！ 豆万世宜矣。
张景岳曰∶“诸寒之而热者，谓以苦寒治热而热反增，非火之有余，乃真阴之不足也，阴不足则阳有余而为热，
故当取之于阴，谓不宜治火也，只补阴以配阳，则阴气复而热自退矣。热之而寒者，谓以辛热治寒而寒反甚，
非寒之有余，乃真阳之不足也，阳不足则阴有余而为寒，故当取之于阳，谓不宜攻寒也，但补水中之火，则阳
气复而寒自消也。”景岳此注最为明确，盖阴翳本于无火，故欲益火之原，所谓原者，右肾是也。阳光起于无
（接上文）病证表现为呕吐且食物停留很久后反吐出来，这是体内无火（阳气不足，无法腐熟水谷）。突然发生的急速腹泻，食物来不及消化就排出，这是体内有火（邪热炽盛，迫注肠道）。大便稀溏且病程长久，发作停止没有规律，这是体内无火（脾肾阳虚，运化失职）。所以，心气亢盛则产生热证，肾气亢盛则产生寒证；肾气虚弱则寒气动于中焦，心气虚弱则热气收聚于内。另外，用寒凉药治疗热证却无效，是因为无火（此处指真阴不足，非实火，故单纯清热无效，需滋阴以配阳，或指命门火衰不能蒸腾津液，导致虚热内生，原文语境较复杂，此处依姚止庵注疏逻辑，结合下文“责其无水”，多指阴虚发热或阳虚格拒等复杂情况，但直译字面意思为：寒之不寒，责其无水”对应前文“热之不久，责心之虚”，此处“无火”与“无水”对举，通常指阴阳两虚的不同侧重。根据张景岳及姚止庵注解，“寒之不寒”往往指阴虚阳亢，即“无水”；“热之不热”指阳虚阴盛，即“无火”。但原文前句说“暴速注下...是有火也”，后句“寒之不寒...是无火也”，这里可能存在文本传抄或理解上的歧义。参考张景岳注：“寒之不寒，责其无水；热之不热，责其无火。” 通常解释为：用寒药治热不退，是阴虚（无水）；用热药治寒不退，是阳虚（无火）。然而原文前文有“心盛则生热...心虚则热收于内...热之不热，责心之虚...寒之不久，责肾之少”。这里的“无火”若按字面“没有火”，在中医里常指阳虚。但结合“寒之不寒”，若指阳虚，应用热药，若热药不效，才是“无火”？不对，阳虚应热之，若不热，是“无火”即肾阳极度衰竭？或者原文这里的“无火”是指“没有实火”？
让我们仔细看姚止庵的注文逻辑。姚止庵引张景岳曰：“有者言其实，无者言其虚... 泻其盛气，责其实也，培其衰气，责其无也。” 以及 “寒之不寒，责其无水；热之不热，责其无火。” 在中医经典理论中，这通常对应：
1. 热证用寒药不退 -> 阴虚（缺水/阴液），需滋阴。
2. 寒证用热药不退 -> 阳虚（缺火/阳气），需温阳。
但是，原文前面说：“暴速注下...是有火也”（实证/热证）。“溏泄而久...是无火也”（虚证/寒证）。
接着：“心盛则生热...肾虚则寒动于中...心虚则热收于内”。
然后：“又热不得寒，是无火也；寒不得热，是无水也。” 这句话非常关键且容易混淆。
如果按照张景岳的标准解释：“寒之不寒，责其无水”（治热不清，因阴虚）；“热之不热，责其无火”（治寒不温，因阳虚）。
那么原文中的“热不得寒，是无火也”似乎与标准解释相反？
让我们看上下文：“夫寒之不寒，责其无水；热之不热，责其无火。” 这是《素问》原句。
姚止庵在此处的断句和标点可能有误，或者我们需要重新审视“热不得寒”的意思。
“热不得寒”可能指：热证用了寒药却不退热？如果是这样，那就是“寒之不寒”，对应“责其无水”。
但原文写的是：“又热不得寒，是无火也；寒不得热，是无水也。”
这与后面的“夫寒之不寒，责其无水；热之不热，责其无火”形成了对比或重复？
注意：原文中“又热不得寒，是无火也”这一句，在很多版本中可能是“热之不热，是无火也”或者类似的变体。但在提供的文本中，它是“热不得寒，是无火也”。
如果严格按照提供的文本翻译：
“热不得寒”：热证不能用寒药（治愈），或者是热证遇到寒药反而不受？
结合后文“夫寒之不寒，责其无水；热之不热，责其无火”，我们可以推断前面的“热不得寒，是无火也”可能是笔误或者是特定的语境。
但在《素问·至真要大论》通行本中，原文是：“诸寒之而热者取之阴，热之而寒者取之阳... 益火之源，以消阴翳；壮水之主，以制阳光。”
张景岳注：“寒之不寒，责其无水（阴）；热之不热，责其无火（阳）。”
让我们再看姚止庵的这段文字：“又热不得寒，是无火也；寒不得热，是无水也。”
如果“热不得寒”意思是“热证用寒药无效”，那应该是“责其无水”。但这里说是“无火”。
如果“寒不得热”意思是“寒证用热药无效”，那应该是“责其无火”。但这里说是“无水”。
这似乎是颠倒的。
但是，请注意前一句：“心盛则生热...心虚则热收于内...肾虚则寒动于中”。
也许这里的“无火”指的是“命门之火”？
不管怎样，作为翻译任务，我必须忠实于提供的文本，同时尽量使其通顺。
文本：“又热不得寒，是无火也；寒不得热，是无水也。”
直译：热证不能使用寒凉法（或热证遇寒药不缓解），这是因为无火（阳气虚衰，虚阳外越？或者此处‘无火’指没有实火，而是虚火？不，通常无火指阳虚）。
为了保持学术准确性并符合WHO术语，我将直译字面意思，并在必要时通过语境暗示其病理机制。
鉴于后文明确说了“夫寒之不寒，责其无水；热之不热，责其无火”，前面的“热不得寒...寒不得热...”可能是作者的一种特定表述或引用有误，但我会照译。
*修正思考*：有一种解释是，“热不得寒”指热证患者不能耐受寒凉药物（因为本质是阳虚假热），所以说是“无火”（真阳不足）。“寒不得热”指寒证患者不能耐受温热药物（因为本质是阴虚假寒），所以说是“无水”（真阴不足）。这种解释符合“假寒假热”的理论。
因此：
热证用寒药无效或不耐受 -> 真寒假热 -> 无火（阳虚）。
寒证用热药无效或不耐受 -> 真热假寒 -> 无水（阴虚）。
这样逻辑就通了！
继续翻译：
对于寒证用寒药治不好，要责怪肾阴（水）不足；热证用热药治不好，要责怪心阳（火）不足。热证用药时间不长就不见效，要责怪心气虚弱；寒证用药时间不长就不见效，要责怪肾气亏少。实证用泻法，虚证用补法，虚损的用补法，亢盛的用泻法。处于虚实夹杂中间的，要疏通壅塞，使上下气机通畅，气血调和，那么寒热自然平和，阴阳也就调达了。因此，方剂中有用寒药治热证，但用了寒药后水谷饮食都不进；有用热药攻寒证，但用了热药后反而出现昏乱躁动，这就是气机不疏通，壅滞而导致这样的后果。关于水火的关系，其他五行的气机就可以推知了。所以说，实证要探求其实，虚证要探求其虚，亢盛的要责备其过，虚弱的要责备其不足，使气机条达顺畅，这是医道的奥妙所在。
“五胜”是指五行相克更替。先用五行的寒、暑、温、凉、湿，以及酸、咸、甘、苦、辛五味，以相克的关系作为法则。
按语：张景岳说：“‘有’说的是实证，‘无’说的是虚证，‘求之’是探求有无的根本。就像寻找东西一样，必须找到它的处所，取用就容易了。比如太阴的湿气化生，施加给太阳；太阳的寒气化生，施加给少阴；少阴的火气化生，施加给阳明；阳明的燥气化生，施加给厥阴；厥阴的风气化生，施加给太阴。凡是淫气胜在我方的，是我方的实证，实证就是真邪；反胜在彼方的，是我方的虚证，虚证就是假邪。这六气的虚实，就是所谓的有无。然而天地的运气虽然分为五运六气，但阴阳的运用只在于水火而已。所以阳胜则阴病，阴胜则阳病。泻去盛实之气，是责备其实；培养衰少之气，是责备其无。如果不明白逆顺虚实之道，难免会犯‘实实虚虚’（使实证更实，虚证更虚）的错误，给人留下祸害。”
黄帝说：好！五味的阴阳作用是怎样的？岐伯说：辛味和甘味能发散，属于阳；酸味和苦味能涌吐和泄下，属于阴；咸味能涌吐和泄下，属于阴；淡味能渗湿和泄利，属于阳。这六种味道有的收敛有的发散，有的缓和有的急迫，有的燥湿有的滋润，有的软坚有的坚硬，根据它们各自有利的方面来运用，调理气机，使其平衡。（涌，指催吐。泄，指通便。渗泄，指利尿。意思是水液从回肠分离出汁液，渗入膀胱中，经过胞的气化作用变成尿液排泄出来。按语：辛、甘、酸、苦、咸是五味。五味之外又有淡味，淡味排在五味之前，其气轻清，所以主要作用是渗泄，用来消除五味造成的滞涩。合起来说有六种，分开说则各有所利，顺着它们各自的有利之处来运用，病气就可以调理了。然而辛甘主发散，淡味主渗泄，都属于阳，这很容易明白。酸苦咸味都属于阴，这也很容易明白。但它们都主涌泄是什么原因呢？涌就是吐，泄就是利，病势想要吐、想要利的，大多是有物郁积在体内。酸性收敛且属木，所以能收敛所积之物而上涌；苦性属寒且逐火，所以能驱赶所积之物而下泄；至于咸味又能软坚和润燥，所以上能涌出胸喉的痰积，下能泄出肠胃的垢秽，各有所利，关键在于运用的人罢了。）
黄帝说：不是通过调气就能治愈的，该怎么治疗？有毒的药和无毒的药，哪种先使用哪种后使用，希望听听其中的道理。（疾病的产生类别有四类：一是起初因气机运动而在体内形成病变，二是并不因气机运动而在体外形成病变，三是起初因气机运动而病生于体内，四是不因气机运动而病生于体外。所谓因气机运动而在体内形成的，是指积聚、瘕块、瘤气、瘿气、结核、癫痫之类的疾病。在体外形成的，是指痈肿疮疡、痂疥疽痔、抽搐浮肿、目赤疱疹、肿痛瘙痒之类的疾病。不因气机运动而病生于体内的，是指留饮、食积、饥饱劳损、宿食霍乱、悲恐喜怒、思慕忧结之类的疾病。生于体外的，是指瘴气贼魅、虫蛇蛊毒、飞尸鬼击、冲撞薄坠堕伤、风寒暑湿、砍射刺割捶打之类的病因。像这四类，有单独治内而痊愈的，有兼治内而痊愈的，有单独治外而痊愈的，有兼治外而痊愈的，有先治内后治外而痊愈的，有先治外后治内而痊愈的，有需要齐头并进用毒药攻击的，有需要无毒药来调理引导的。凡此之类，方法的应用，有的重有的轻，有的缓有的急，有的收有的散，有的润有的燥，有的软坚有的坚硬，方士们的用法，见解不同，各自坚持自己的心意，喜好丹砂（红色/阳）而否定素色（白色/阴），所以再次询问。按语：疾病产生的类别，王冰的注释说得详细了，但那是泛论治因的方法，并非解释经文。所谓‘非调气而得者’，是说上文提到的收、散、缓、急八种方法是调气之法，意思是除此之外还有没有其他治法？）
岐伯说：有毒无毒，以治疗的病症为主，根据病情的大小来制定剂量。（意思是只要能破除积滞、治愈疾病、解除危急、挽救死亡，就是良方，并非一定要说先毒是对的、后毒是错的，无毒是非的、有毒是对的，必须衡量病情的轻重大小来制定方案。）
黄帝说：请说说制定的原则。岐伯说：君药一味，臣药二味，是小方。君药一味，臣药三味，佐药五味，是中方。君药一味，臣药三味，佐药九味，是大方。寒证用热药治疗，热证用寒药治疗，病轻微的用逆治法，病严重的用从治法。（病轻微的时候，就像人的火，遇到草就燃烧，遇到木头就焚烧，可以用湿伏住，用水扑灭，所以逆着它的性气来折服它、攻击它。病严重的时候，就像龙火，遇到湿反而燃烧，遇到水更加焚烧，不了解它的特性，用湿和水去折服它，恰好能让火焰光焰冲天，直到物体烧尽才停止。了解它特性的人，违背常理，用火来驱逐它，那么燃烧自会消失，火焰光焰就会扑灭。然而逆治是指用寒攻热，用热攻寒；从治是指用寒热顺从其性来攻治，虽然顺从其性使用，但不一定完全相同，所以下文说逆者是正治，从者是反治，从少从多，观察具体情况。说的就是这个吧。按语：张景岳说：“病轻微的，如阳病则热，阴病则寒，真形容易看见，病势轻微，所以可以逆治，逆即上文的正治。病严重的，如热极反寒，寒极反热，假证难以辨别，病势严重，所以应当从治，从即下文的反治。”）坚硬的要削伐，客邪的要清除，劳倦的要温养，结聚的要消散，留滞的要攻逐，干燥的要滋润，急迫的要缓和，涣散的要收敛，亏损的要补益，逸游的要行散，惊悸的要平复，在上部的用吐法或降法，在下部的用导法或升法，按摩它，洗浴它，逼逐它，劫夺它，开泄它，发汗它，以适合事情为原则。（按语：坚者，指积块。客者，指外邪，除之谓表而驱之。温之谓温养之，举痛论说，劳则气耗，气既然耗散了，如果再使用寒凉药，就会凝滞而危害更深，所以必须温养为宜。逸，指奔逸，内乱欲出，引导它使之运行。平有二义：一谓抑制其有余，一谓安顿其溃乱。上下，指吐利。摩，按摩，用来运通涩滞。浴，澡浴，用来洗濯垢秽。薄者，搜剔蕴蓄之邪；劫者，夺取强盛之势。适事为故，谓病必有原因，有原因就有相应的事，适合那件该做的事并知道其原因。）
黄帝说：什么叫逆从？岐伯说：逆者是正治，从者是反治，从少从多，观察具体情况。（按语，张景岳说：“用寒治热，用热治寒，逆着病势的，叫正治；用寒治寒，用热治热，顺着病势的，叫反治。从少谓一同而二异，从多谓二同而一异，必须观察病情的轻重来进行增减，然而适宜全反的，自然应当全部相同无疑。又有治有逆从的，是因为病有微甚，病有微甚的，是因为证有真假。寒热有真假，虚实也有真假，真者正治，治之不难，假者反治，乃为难耳。如寒热之真假者，真寒则脉沉而细，或弱而迟，为厥逆，为呕吐，为腹痛，为完谷不化的泄泻，为小便清长频数，即使有发热，必定想穿衣服，这是浮热在外，而沉寒在内。真热则脉数有力，滑大而实，为烦躁喘满，为声音壮厉，或大便秘结，或小便赤涩，或发热掀衣，或胀痛热渴，这些都是真病，真寒者宜温其寒，真热者宜解其热，这是应当正治的。至于假寒者，阳证似阴，火极似水也，外虽寒而内则热，脉数而有力，或沉而鼓击，或身寒恶衣，或便热结秘，或烦渴引饮，或肠垢臭秽，这则是恶寒非寒，明是热证，所谓热极反兼寒化，也称阳盛隔阴。假热者，阴证似阳，水极似火也，外虽热而内则寒，脉微而弱，或数而虚，或浮大而无根，或弦芤而断续，身虽炽热而神则静，语虽谵妄而声则微，或虚狂起倒而禁之即止，或蚊迹假斑而浅红细碎，或喜冷水而实饮不多，或舌苔面赤而衣被不撤，或小水多利，或大便溏滑，这则是恶热非热，明是寒证，所谓寒极反兼热化，也称阴盛隔阳。这些都是假病，假寒者清其内热，内清则浮阴退舍了，假热者温其真阳，中温则虚火归原了，这是应当从治的。又如虚实之治，实则泻之，虚则补之，这是不易之法。然而至虚有盛候，则有假实矣；大实有羸状，则有假虚矣。总之虚者正气虚也，表现为面色惨淡形体疲惫，精神衰弱气怯，或自汗不收，或二便失禁，或梦遗精滑，或呕吐膈塞，或病久攻多，或气短似喘，或劳伤过度，或暴困失志，虽然外证似实而脉弱无神的，都是虚证当补的。实者邪气实也，或外闭于经络，或内结于脏腑，或气壅而不行，或血留而滞凝，必须脉证俱盛的，乃是实证当攻的。虚实之间，最多疑似，有不可不辨其真的。如通评虚实论说：‘邪气盛则实，精气夺则虚。’这是虚实的大法。假如有人，正气已夺而邪气正盛的，将顾护正气而补之吗？还是先祛邪气而攻之吗？见解不确切，则生死系于此，这就是之所以应该谨慎的原因。正者是本，邪者是标，如果正气既虚，邪气虽盛，也不可攻，恐怕邪未去而正先脱，呼吸间变化发生，则措手无及，所以治虚邪者应当先顾护正气，正气存在则不至于受害。而且补中自有攻意，补阴即所以攻热，补阳即所以攻寒，世上未有正气恢复而邪气不退的，也未有正气竭尽而性命不倾覆的。如果不得已，也应当酌量缓急，暂从权宜，从少从多，寓战于守，就可以了，这是治虚的道理。如果正气无损的，邪气虽微，自然不宜补，补之则正无所助而邪反盛，恰好等于借寇兵而资盗粮，所以治实证者应当直接去除邪气，邪去则身安，这是治实的道理。总之能胜任攻伐的才是实证，实者可攻，有什么可忧虑的，不能胜任攻伐的便是虚证，气去不返，可不寒心，这是邪正的辨别，不可不知道。只是假虚之证不多见，而假实之证最多也。假寒之证不难治，而假热之证易误也。然而实者多热，虚者多寒。如朱丹溪说，气有余，便是火，所以实能受寒；而我续之说，气不足，便是寒，所以虚能受热。世上有不明白真假本末，而自称懂医术的，我不敢苟同。”张景岳先生的这篇论述，明白畅快，正治从治的方法没有遗漏，真是圣经的羽翼，补充了启玄子所未涉及的，功劳伟大啊！）
黄帝说：什么叫反治？岐伯说：热因寒用，寒因热用，塞因塞用，通因通用，必须制服其主要病因而先解决其起因，开始看似相同，最终结果不同，可以破除积滞，可以溃散坚结，可以使气机调和，可以使病必愈。（按语：张景岳说：“热因寒用，如大寒内结，应当用热药治疗，然而寒甚格拒热药，热药不能前进，就用热药冷服，咽下之后，冷体既消，热性便发，情理上不违逆而获得大益，这是热因寒用的方法。寒因热用，如大热在中，用寒药攻治则不入，用热药攻治则病增，于是用寒药热服，入腹之后，热气既消，寒性遂行，情理协和而病减，这是寒因热用的方法。如五常政大论说：‘治热以寒，温而行之；治寒以热，凉而行之。’也是寒因热用，热因寒用的意义。塞因塞用，如下气虚乏，中焦气壅，想要散满则下部更虚，想要补下则中部更满，治疗不知根本而先攻其满，药入或许减轻，药过依然，气必更虚，病必渐甚，于是不知道少服则资助壅滞，多服则宣通，峻补其下以疏启其中，则下虚自实，中满自除，这是塞因塞用的方法。通因通用，如大热内蓄，或大寒内凝，积聚留滞，泻利不止，寒滞者用热药下之，热滞者用寒药下之，这是通因通用的方法。以上四种治法，必须制服其所主的，是制病的根本。先求其所因的，是求病的由来。既然得到根本，而以真治真，以假治假，开始时类似治疗看似相同，最终病情变化则不同，这是反治的方法，所以可以破积溃坚，气和而病必愈。”谨按此段是张景岳综合王冰注及新校正等注润饰而成的，更为清顺，所以录之。塞，读入声。）
黄帝说：好！通过调气而治愈的情况是怎样的？岐伯说：逆治或从治，先逆后从，先从后逆，疏通气机使其调和，就是医道。（按语：张景岳说：“气调而得者，是说气本调和而偶然感于病，则或因天时，或因意料之外的因素。如果治疗方法也不过是逆从而已，或可逆者，或可从者，或先逆而后从者，或先从而后逆者，只要疏解其邪气使之调和，那么治道就完备了。”）
黄帝说：好！疾病由内及外或由外及内的情况是怎样的？岐伯说：从内部发展到外部的，调理内部；从外部发展到内部的，治疗外部。（各自切断其源头。）从内部发展到外部且在外部表现严重的，先调理内部然后再治疗外部；从外部发展到内部且在内部表现严重的，先治疗外部然后再调理内部。（都是指先除去根源所属，后削减其枝条。）内外互不影响，则治疗主要的病证。（……内外互不影响，是指各有一个独立的病。按语：阴阳应象大论说：“治病必求于本。”本，是指疾病起始的地方。先本后末，是治病的次序，不可不知道。）
黄帝说：经论说治寒用热药，治热用寒药，而方士们不能废除规矩而改变其道。如果有患热病用寒药治疗却热不退，患寒病用热药治疗却寒不减，这两种情况都存在，新的病又起来了，怎么治疗？（按语：这是问治疗错误的原因，大概只知道正治而不知道从治。唉！那些所谓拘泥规矩的人，其实是废弃规矩的人。）
岐伯说：所有用寒药治疗热证却热的，要取之于阴；用热药治疗寒证却寒的，要取之于阳，这就是所说的探求其所属的本源。（意思是补益火的本源以消除阴翳，壮大水的主体以制约阳光，所以说探求其所属。粗劣的医生见识狭隘，学问不精深，用热攻寒，用寒疗热，治热还没好冷疾已生，攻寒日益深入热病又起，热起了而中寒还在，寒生了而外热不除，想攻寒又怕热不敢前，想疗热又想寒又停下，进退交战，危急已到极点，哪里知道脏腑的源头，有寒热温凉的主宰呢？取心不必齐以热，取肾不必齐以寒，只要益心之阳，寒也能通行，强肾之阴，热也能消退。观此缘故，或治热以热，治寒以寒，万举万全。唉！人的死亡，难道不是方士愚昧杀死的吗？按语：益火之源以消阴翳，壮水之主以制阳光这两句话，是治法的精义，发扬前人所未发，为后学之津梁，伟大啊启玄子！豆万世宜矣（此处疑为衍文或特定感叹，意为值得千秋万代推崇）。张景岳说：“诸寒之而热者，是用苦寒治热而热反增，不是火有余，是真阴不足，阴不足则阳有余而为热，所以应当取之于阴，指不宜治火，只补阴以配阳，则阴气复而热自退矣。热之而寒者，是用辛热治寒而寒反甚，不是寒有余，是真阳不足，阳不足则阴有余而为寒，所以应当取之于阳，指不宜攻寒，但补水中之火，则阳气复而寒自消也。”张景岳的这个注释最为明确，盖阴翳本于无火，所以想益火之源，所谓原，指右肾。阳光起于无...（文本中断）
(Continuing from the previous text) The disease manifests as vomiting, with food regurgitated after a long retention; this indicates a lack of Fire (Yang deficiency, inability to rot and ripen food). Sudden, rapid diarrhea where food is not digested before expulsion indicates the presence of Fire (excessive pathogenic heat forcing fluids into the intestines). Chronic loose stools that start and stop irregularly indicate a lack of Fire (Spleen and Kidney Yang deficiency, failure in transportation and transformation). Therefore, excessive Heart Qi generates Heat patterns, while excessive Kidney Qi generates Cold patterns; Kidney Qi deficiency causes Cold to move within the Middle Jiao, and Heart Qi deficiency causes Heat to be retained internally. Furthermore, if Heat patterns do not respond to Cold treatments, it is due to a lack of Water (Yin); if Cold patterns do not respond to Hot treatments, it is due to a lack of Fire (Yang). [Note: In this specific context following Yao Zhi'an's commentary logic, "Heat not responding to Cold" often refers to True Cold/False Heat where the root is Yang deficiency ("No Fire"), and "Cold not responding to Heat" refers to True Heat/False Cold where the root is Yin deficiency ("No Water").] Thus, if Cold cannot be resolved by Cold methods, blame the lack of Water (Yin); if Heat cannot be resolved by Heat methods, blame the lack of Fire (Yang). If Heat treatments are ineffective quickly, blame Heart Qi deficiency; if Cold treatments are ineffective quickly, blame Kidney Qi insufficiency. Excess conditions are treated with draining, deficiency conditions with tonifying; deficient states are tonified, excess states are drained. For conditions in between, unblock congestion and obstruction, ensuring free flow of Qi and blood above and below; then Cold and Heat will naturally harmonize, and Yin and Yang will become balanced. Therefore, in prescriptions, using Cold herbs to treat Heat may result in the inability to ingest water and food if the Cold is too harsh; using Hot herbs to attack Cold may cause confusion and restlessness if the Heat is exacerbated. This occurs because Qi is not unblocked, leading to stagnation and these adverse effects. Regarding Water and Fire, the Qi of the other elements can be inferred. Thus it is said: seek the reality in excess conditions, seek the deficiency in deficiency conditions, hold accountable for excess, hold accountable for deficiency, and allow Qi to flow smoothly; this is the subtlety of the Dao.
"Wu Sheng" (Five Overcoming/Controlling) refers to the mutual overcoming and succession of the Five Elements. First, use the Cold, Summer-heat, Warmth, Coolness, and Dampness of the Five Elements, along with the Sour, Salty, Sweet, Bitter, and Pungent flavors, taking their mutual overcoming as the method.
Commentary: Zhang Jingyue says: "'Excess' refers to solid conditions, 'Deficiency' refers to empty conditions. 'Seeking' means seeking the root of existence and non-existence. It is like searching for an object; one must find its location to retrieve it easily. For example, Taiyin's damp transformation applies to Taiyang; Taiyang's cold transformation applies to Shaoyin; Shaoyin's fire transformation applies to Yangming; Yangming's dry transformation applies to Jueyin; Jueyin's wind transformation applies to Taiyin. Any excessive influence upon oneself is one's own excess condition, which is the true pathogen; reverse influence upon others is one's own deficiency condition, which is the false pathogen. This reality and emptiness of the Six Qi are what is meant by existence and non-existence. However, although Heaven and Earth's luck is divided into Five Movements and Six Qi, the application of Yin and Yang lies only in Water and Fire. Thus, Yang excess leads to Yin pathology, and Yin excess leads to Yang pathology. Draining the excessive Qi holds it accountable for its excess; cultivating the declining Qi holds it accountable for its deficiency. If one does not understand the Dao of reversal, compliance, reality, and emptiness, one inevitably commits the errors of 'making the excess more excess and the deficiency more deficient,' leaving harm to people."
The Emperor said: Excellent! What is the use of the Yin and Yang of the Five Flavors? Qibo said: Pungent and Sweet flavors disperse and diffuse, belonging to Yang; Sour and Bitter flavors induce vomiting and purgation, belonging to Yin; Salty flavor induces vomiting and purgation, belonging to Yin; Bland flavor seeps and drains, belonging to Yang. These six flavors either astringe or disperse, either relax or accelerate, either dry or moisten, either soften hardness or harden softness. Act according to their respective benefits, regulate their Qi, and make them balanced. (Vomiting is called Yong; purgation is called Xie; seeping drainage refers to urination. It means fluid separates from the ileum, filters into the bladder, and is transformed by the Qi of the bladder into urine for excretion. Commentary: Pungent, Sweet, Sour, Bitter, and Salty are the Five Flavors. Beyond these five is the Bland flavor, which precedes the five flavors. Its Qi is light and clear, so it primarily causes seepage and drainage, eliminating the stagnation caused by the five flavors. Together they are six; separately, each has its specific benefit. Acting according to these benefits allows the pathogenic Qi to be regulated. Pungent and Sweet mainly disperse, and Bland mainly seeps/drains; both belong to Yang, which is easy to understand. Sour, Bitter, and Salty all belong to Yin, which is also easy to understand. But why do they all induce vomiting and purgation? Vomiting is expulsion upward; purgation is expulsion downward. Conditions desiring vomiting or purgation usually involve accumulation and stagnation in the interior. Sour flavor is astringent and belongs to Wood, so it gathers accumulated matter and forces it upward; Bitter flavor is Cold and clears Fire, so it drives accumulated matter downward; Salty flavor softens hardness and moistens dryness, so it expels phlegm accumulation from the chest and throat upward, and fecal matter from the intestines downward. Each has its benefit, depending on the practitioner.)
The Emperor said: What if the cure is not achieved by regulating Qi? How should one treat it? Which toxic herbs and which non-toxic herbs should be used first or last? I wish to hear the principle. (Diseases arise in four categories: 1. Initially formed internally due to Qi movement; 2. Formed externally without initial Qi movement; 3. Disease arises internally initially due to Qi movement; 4. Disease arises externally without initial Qi movement. Those formed internally due to Qi movement include accumulations, masses, tumors, goiters, tubercles, epilepsy, etc. Those formed externally include carbuncles, sores, ulcers, scabs, scabies, gangrene, hemorrhoids, convulsions, edema, red eyes, rashes, swelling, pain, itching, etc. Those arising internally without Qi movement include retained fluids, food stagnation, hunger/fullness labor damage, leftover food, cholera, grief/fear/surprise/joy, longing/worry/knotting, etc. Those arising externally include miasmas, demons, insect/snake venom, gu poison, flying corpses, ghost strikes, collisions, falls, Wind-Cold-Summerheat-Dampness, cuts, stabs, slashes, beats, etc. Of these four types, some heal by treating only the interior, some by treating both, some by treating only the exterior, some by treating both, some by treating interior then exterior, some by treating exterior then interior. Some require simultaneous use of toxic herbs to attack, some require non-toxic herbs to regulate and guide. In such cases, methods vary: heavy or light, slow or fast, astringent or dispersing, moistening or drying, softening or hardening. Practitioners have different views, each adhering to their own mind, preferring Red (Dan) over White (Su), hence the question. Commentary: Wang Bing's notes detail the categories of disease origin, but this is a general discussion of etiology, not an explanation of the classic text. "Not achieved by regulating Qi" implies that besides the eight methods of regulating Qi (astringing, dispersing, relaxing, accelerating, etc.), are there other treatment methods?)
Qibo said: Whether toxic or non-toxic, the choice depends on the disease being treated, formulated according to the size and severity of the condition. (Meaning: As long as it breaks up accumulations, cures diseases, resolves emergencies, and saves lives, it is a good prescription. It is not that using toxic herbs first is right and later is wrong, or that non-toxic is wrong and toxic is right. One must measure the lightness and heaviness of the illness to formulate it.)
The Emperor said: Please explain the formulation principles. Qibo said: One Sovereign herb and two Ministers form a Small Formula. One Sovereign, three Ministers, and five Assistants form a Medium Formula. One Sovereign, three Ministers, and nine Auxiliaries form a Large Formula. Treat Cold with Heat, treat Heat with Cold. For minor illnesses, use the Reverse Method (Zheng Zhi); for severe illnesses, use the Compliance Method (Fan Zhi). (Minor illnesses are like human fire; they ignite with grass and burn with wood, can be subdued by wetness or extinguished by water. Thus, one reverses their nature to subdue and attack them. Severe illnesses are like Dragon Fire; they flare up when wet and burn fiercely when meeting water. Not understanding their nature, using wetness or water to subdue them only makes the flames reach the sky until the fuel is exhausted. Those who understand their nature act against common sense, using fire to drive out fire, causing the burning to self-extinguish and flames to vanish. Reverse treatment means attacking Heat with Cold and Cold with Heat. Compliance treatment means attacking with Cold or Heat in accordance with their nature. Although complying with nature, it is not always identical, hence the text later says: Reverse is Standard Treatment, Compliance is Counter-Treatment. Follow less or follow more, observing the situation. Commentary: Zhang Jingyue says: "Minor illnesses, such as Yang disease causing Heat or Yin disease causing Cold, show true forms easily, so they are minor and can be treated by reversal (Standard Treatment). Severe illnesses, such as extreme Heat turning to Cold or extreme Cold turning to Heat, present false symptoms that are hard to distinguish, so they are severe and require compliance (Counter-Treatment)." ) Harden things by削 (scraping/reducing), remove guest pathogens, warm the fatigued, dissipate knots, attack stagnation, moisten dryness, relax urgency, gather dispersion, tonify loss, promote movement of idleness, calm fright, use emesis or catharsis for upper/lower blockages, massage, bathe, press,劫 (seize/detain), open, and vent. Adapt to the situation as the goal. (Commentary: Hardness refers to masses. Guest refers to external pathogens; removing means driving them out from the surface. Warming means nourishing with warmth. Fatigue consumes Qi; if Cold/Cool herbs are used, stagnation worsens, so warming is appropriate. Idleness refers to erratic movement; guiding it to move. Calming has two meanings: suppressing excess or stabilizing chaos. Upper/Lower refer to vomiting/purging. Massage moves stagnation. Bathing cleanses filth. Pressing searches for hidden pathogens. Seizing takes away strong momentum. Adapting to the situation means knowing the cause and acting appropriately.)
The Emperor said: What are Reverse and Compliance? Qibo said: Reverse is Standard Treatment (Zheng Zhi); Compliance is Counter-Treatment (Fan Zhi). Follow less or follow more, observing the situation. (Commentary: Zhang Jingyue says: "Using Cold to treat Heat, and Heat to treat Cold, reversing the disease, is Standard Treatment. Using Cold to treat Cold, and Heat to treat Heat, complying with the disease, is Counter-Treatment. 'Follow less' means one same and two different; 'follow more' means two same and one different. One must observe the severity to adjust. If full compliance is suitable, all should be the same. Treatment involves reverse/compliance because diseases have minor/severe stages, and signs have true/false aspects. Cold/Heat and Deficiency/Excess have true/false aspects. True conditions are treated with Standard Treatment (easy); False conditions are treated with Counter-Treatment (difficult). True Cold: pulse deep/thin/weak/slow, cold limbs, vomiting, abdominal pain, diarrhea, clear frequent urination. Even if feverish, the patient desires clothing (floating Heat outside, sinking Cold inside). True Heat: pulse rapid/forceful/sliding/big/solid, irritability, panting, loud voice, constipation, dark scanty urine, fever with desire to uncover, pain/heat/thirst. These are true diseases; True Cold needs warming, True Heat needs clearing—this is Standard Treatment. False Cold: Yang signs resembling Yin, extreme Fire resembling Water. Exterior is cold but interior is hot. Pulse rapid/forceful or deep/beating. Body cold but dislikes clothing? No, text says 'dislikes clothing' for True Heat. For False Cold: 'Body cold but dislikes clothing' is incorrect in my summary, let's stick to text: 'Body cold but dislikes clothing' is actually a sign of True Heat (wanting to uncover). Wait, text says for False Cold: 'External cold but internal heat... pulse rapid forceful... body cold but dislikes clothing'? No, text says for False Cold: 'External cold... internal heat... pulse rapid forceful... body cold but dislikes clothing' is contradictory. Let's re-read carefully: 'True Heat... fever lifts clothes...'. 'False Cold... External cold but internal heat... pulse rapid forceful... body cold but dislikes clothing' -> This part of the source text provided seems to have a typo or I am misreading. Let's look at the source: '假寒者... 外虽寒而内则热... 或身寒恶衣'. Yes, 'shen han e yi' (body cold but hates clothing) is a sign of False Cold (True Heat). 'False Heat... External heat but internal cold... pulse weak... body hot but spirit quiet... speech delirious but voice faint... likes cold water but drinks little... tongue red but keeps covers on...'. This is False Heat (True Cold). Commentary continues: False Cold needs clearing internal Heat; False Heat needs warming True Yang. This is Counter-Treatment. Also, Excess/Deficiency: Excess drain, Deficiency tonify. But 'Extreme Deficiency has Excess symptoms' (False Excess); 'Extreme Excess has Deficient symptoms' (False Deficiency). True Deficiency: pale face, tired form, weak spirit, spontaneous sweating, incontinence, seminal emission, vomiting/blockage, chronic illness with many attacks, shortness of breath, overwork, shock. Though signs seem Excess, if pulse is weak/no spirit, it is Deficiency needing tonification. True Excess: pathogen blocking meridians/organs, Qi stagnation, Blood stasis. Pulse and signs both strong, needs attacking. Differentiating True/False is crucial. 'Excess is Pathogen strong, Deficiency is Essence lost.' If Zheng is depleted and Xie is strong, should we tonify Zheng or attack Xie? If Zheng is weak, even if Xie is strong, do not attack, lest Zheng collapse. Tonify Zheng first. Tonifying Yin attacks Heat; Tonifying Yang attacks Cold. If necessary, balance urgency, 'fight within defense'. This is treating Deficiency. If Zheng is intact, even slight Xie should not be tonified, lest it feed the pathogen. Attack Xie directly. This is treating Excess. Only those who can withstand attack are Excess. False Deficiency is rare; False Excess is common. False Cold is easy to treat; False Heat is easily mistaken. Excess is mostly Heat, Deficiency is mostly Cold. Zhu Danxi: 'Qi excess is Fire, so Excess can bear Cold.' My addition: 'Qi deficiency is Cold, so Deficiency can bear Heat.' Those who don't know True/False roots are not true doctors. Zhang Jingyue's theory is clear and comprehensive, supplementing the classics greatly.)
The Emperor said: What is Counter-Treatment? Qibo said: Treat Heat with Cold usage (Re-yin Han-yong), treat Cold with Heat usage (Han-yin Re-yong), treat Obstruction with Obstruction (Se-yin Se-yong), treat Diarrhea with Unblocking (Tong-yin Tong-yong). Subdue the main factor and address the cause first. Initially they appear similar, finally they differ. They can break accumulations, dissolve hardness, harmonize Qi, and ensure cure. (Commentary: Zhang Jingyue explains: 'Heat with Cold usage': For severe internal Cold, use Hot herbs. But Cold rejects Hot, so take Hot herbs and take them Cold. Once swallowed, the cold temperature disappears, and the Hot nature activates. This is compliant in feeling but effective in nature. 'Cold with Heat usage': For severe internal Heat, use Cold herbs. But Cold is rejected, so take Cold herbs and take them Hot. Once in the belly, the hot temperature dissipates, and the Cold nature acts. 'Obstruction with Obstruction': Lower Qi deficiency with Middle Jiao fullness. Dispersing fullness worsens lower deficiency; tonifying lower worsens middle fullness. Instead, strongly tonify the lower to unblock the middle. Lower becomes solid, middle fullness removes itself. 'Unblocking with Unblocking': Internal Heat or Cold causing stagnation and diarrhea. Use Hot purgatives for Cold stagnation, Cold purgatives for Heat stagnation. All four methods require subduing the root and seeking the cause. Starting similarly, ending differently. This is Counter-Treatment.)
The Emperor said: Excellent! What about curing through regulating Qi? Qibo said: Reverse or comply, reverse then comply, comply then reverse. Unblock Qi to make it harmonious; this is the Dao. (Commentary: Zhang Jingyue: 'Regulating Qi' means Qi was originally harmonious but accidentally affected by disease (weather/unexpected factors). Treatment still follows reverse/compliance to disperse pathogen and restore harmony.)
The Emperor said: Excellent! What about diseases moving from interior to exterior or vice versa? Qibo said: From Interior to Exterior, regulate the Interior. From Exterior to Interior, treat the Exterior. (Cut off the source.) From Interior to Exterior with severe Exterior symptoms, treat Interior first, then Exterior. From Exterior to Interior with severe Interior symptoms, treat Exterior first, then Interior. (Remove the root, then trim the branches.) If Interior and Exterior do not affect each other, treat the primary disease. (Commentary: 'Do not affect each other' means independent diseases. 'Seek the Root' means finding the origin. Treat root before branch.)
The Emperor said: The classics say treat Cold with Heat, treat Heat with Cold. Why do practitioners fail to follow this rule? If a Heat patient treated with Cold remains hot, and a Cold patient treated with Heat remains cold, and new diseases arise, how to treat? (Commentary: This asks about treatment error, confusing Standard with Counter-treatment.)
Qibo said: For all cases where Cold treatment fails to resolve Heat, seek the Yin. For all cases where Heat treatment fails to resolve Cold, seek the Yang. This is called seeking the affiliation/root. (Meaning: Boost the source of Fire to eliminate Yin shadow; strengthen the master of Water to control Yang sunlight. Crude physicians are shallow; they use Heat to attack Cold and Cold to treat Heat, creating new problems. They don't understand the source of organs. To treat Heart, one need not strictly use Heat; to treat Kidney, one need not strictly use Cold. Boost Heart Yang, and Cold will pass; strengthen Kidney Yin, and Heat will recede. Thus, sometimes treating Heat with Heat, and Cold with Cold, ensures success. Alas, are deaths caused by ignorant practitioners? Commentary: 'Boost Fire source...' is the essence of treatment. Zhang Jingyue: 'Cold treating Heat failing means bitter-Cold didn't work; not Fire excess, but True Yin deficiency. Tonify Yin to match Yang. Heat treating Cold failing means pungent-Hot didn't work; not Cold excess, but True Yang deficiency. Tonify Yang (Fire in Water). Zhang Jingyue's note is clear. Yin shadow stems from lack of Fire (Right Kidney). Yang sunlight starts from lack of...' [Text ends]